New FTN chief calls for big cut in commissioner underspends

The new chief executive of the Foundation Trust Network has called for NHS commissioners to significantly cut the proportion of health funding they leave unspent.

Chris Hopson used his first full interview since taking on the role to argue that the £1.6bn underspend recorded by primary care trusts and strategic health authorities last year was “far too big a cushion” and should be reduced.

Echoing the position of his predecessor Sue Slipman, he told HSJ that one of his first priorities over the next six months would be to ensure the detailed rules governing the reformed NHS were not set in a way that left “too much risk” sitting with providers.

‘Any public sector organisation needs a cushion, but a cushion of £1.6bn on a £100bn budget is far too big’

But Mr Hopson added that he would also focus on ensuring the voice of foundation trusts was heard in the media. He suggested the underspend recorded by commissioners last year was a “good example of where providers are really entitled to jump up and down and say ‘what’s going on here?’”

The former board-level director at HM Revenue and Customs, continued: “When I was at HMRC we had a £4.2bn budget, and the idea that we wouldn’t spend that almost right to the last penny would have been extraordinary.”

He acknowledged that the NHS needed a buffer to protect against unforeseen expenses, but argued that the amounts that had been held back by commissioners were excessive.

“Any public sector organisation needs a cushion, but a cushion of £1.6bn on a £100bn budget is far too big. You should be looking to achieve 0.2, 0.4, half of 1 per cent,” he said. “Not 1.6 per cent.”

He suggested he was also interested in looking at how all parts of the NHS could “come together” to make the case for service reconfiguration.

“I’m very struck by how everybody is now talking in the open – inside the NHS – about the need for extensive service reconfiguration,” he said. “We have to do something that’s clearly pretty significant, and it’s going to be unpopular. The real question is how the NHS as a whole can come together to make that work.”

However, he revealed that when he was working in politics 20 years ago he had run the kind of “save our hospital” political campaigns that those seeking reconfiguration would now have to defuse.

“I used to run parliamentary by-election campaigns,” he told HSJ. “The first thing you used to do was research the local hospital and run a campaign to save the local hospital.”

He said was the tactic he employed in 1989, when he was campaigning for Social Democrat Mike Potter in a by-election in Richmond, Yorkshire against Conservative William Hague, and the SDP ran a “Save Friarage Hospital” campaign.

“I’ve been on the other side of the fence, and I know it’s incredibly tempting to run those campaigns”, he added.

He also told HSJ that – since taking his job – he had consistently heard that it was becoming harder to find good candidates for chief executive posts, and called on the health service to be more supportive of those in the top jobs. One headhunter had described to him how three providers she was working with had all failed to lure former trust chief executives back into the NHS from new jobs in the charity sector.

He said it was “incredibly easy to have a pop at trust chief executives, look at the amount of money they’re on etc”, but “actually these are some of the most important individuals to making the NHS work”.

“If you sit there and you’ve got the regulator pointing the finger, you’ve got local commissioners giving you a really hard time in contract negotiations, and you’ve got people saying you’ve missed this really important target by 0.1 per cent you can see why [that can make] the job extremely difficult and unrewarding,” he added.

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